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Purpose This multicenter study was aimed to evaluate the coincidence of degenerative knee cartilage lesions with a varus or valgus dysalignment. Furthermore, the frequency of the combined surgery of cartilage treatments and corrective osteotomies are determined. Material and Methods A total of 1778 patients were included in the German CartilageRegistry (deadline 01.08.2016). In 90.6% of patients, the surgeon calculated the alignment by clinical observation. Varus or valgus conditions were measured radiologically in only 56.0%. This study describes patients who underwent treatment of degenerative cartilage lesions with a complete (clinical and radiological) determination of the alignment. Results The mean mechanical tibia-femur angle (Paley) (mTFA) in clinically neutral extremities was 0.2° (SD 0.6; 0 - 5), in varus cases 5,0° (SD 3.2; 0 - 15), and - 4.7° (SD - 4.0; - 15 - 0) in valgus cases. Varus dysalignment was significantly associated with cartilage lesions in the medial compartment. Valgus dysalignment more frequently occurred in knees with lateral cartilage lesions. Independently of the surgeon's choice of the method of cartilage surgery, in 72.4% of all valgus deformities a corrective osteotomy was performed. Valgus dysalignment was corrected in 50%. Conclusions In about a quarter of all cases, cartilage lesions are associated with a varus (18.9%) or valgus (4.2%) dysalignment. In a number of cases, the treatment of cartilage lesions should include the addressing of these axial deviations. Still the efficacy of this procedure regarding prognosis and clinical outcome is unclear., Competing Interests: Interessenkonflikt: Nein., (Georg Thieme Verlag KG Stuttgart · New York.)

This is the case of an 84-year-old patient 18 years after total knee replacement. Regular follow-up examinations did not take place beyond 10 years of implantation, so that subsequent wear of the polyethylene insert was not detected. The patient presented because of knee pain, swelling of the calf, and a drop foot. Examination showed a large ganglion with pressure on the peroneal nerve, and a loose knee replacement with severe inlay wear and extensive osteolysis around the tibial and femoral implants. This rare case demonstrates the importance of regular clinical and radiological follow-up examinations after total joint replacements, particularly in the long term., (Georg Thieme Verlag KG Stuttgart · New York.)

Aims: Assessment of left ventricular (LV) systolic function plays a central role in cardiac imaging. Calculation of ejection fraction (EF) is the current method of choice; however, its limited intermodal comparability represents a major drawback. The assessment of myocardial mechanics by strain imaging may better reflect the complex myocardial contractility. We aimed to evaluate different methods for quantification of LV strain on global and regional levels with a focus on the new non-proprietary feature tracking (FT) algorithm., Methods and Results: Measurements of LV deformation were performed by means of high-resolution two-dimensional (2D) speckle tracking echocardiography (STE) and compared with values obtained by 2D feature tracking echocardiography (FT-E) and feature tracking cardiac magnetic resonance imaging (FT-CMR). Assessments with echocardiography started within 30 min after CMR examination to minimize time-dependent variations in myocardial function. Forty-seven patients were included. Assessments by STE were -15.7 ± 5.0% for global longitudinal strain (GLS), -14.6 ± 4.5% for global circumferential strain (GCS), and 21.6 ± 13.3% for global radial strain (GRS), while values obtained with FT-E were -13.1 ± 4.0, -13.6 ± 4.0, 20.3 ± 9.5, and with FT-CMR -15.0 ± 4.0, -16.9 ± 5.4, and 35.0 ± 10.8, respectively. Linear regression and the Bland-Altman analysis showed the best intramodal association for STE GLS and FT-E GLS (r = 0.88, bias = -2.7%, LOA = ±4.7%). The correlation for GCS and GRS was weaker, and for regional strain was poor. In contrast to EF, GLS showed a better intermodal correlation between echocardiography and CMR (r = 0.81 by speckle tracking, r = 0.8 by FT, and r = 0.78 by EF)., Conclusion: In our study, measurement of global longitudinal LV strain using the new FT algorithm with CMR and echocardiography was comparable with measurements obtained by high-resolution STE. Compared with echocardiographic EF determination, FT-E GLS shows a better reproducibility and a better intermodal agreement with CMR, representing a fair non-proprietary solution for this assessment., Clinical Trial Registration: clinicaltrials.gov. Unique identifier: NCT01275963., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.)

To determine bone morphogenetic protein (BMP)-2 protein and Aggrecan in osteoarthritic and healthy cartilage with special regard to localization and degree of cartilage damage 95 samples representing osteoarthritic cartilage and 17 samples out of normal cartilage were graded histological by Mankin Score and were studied by immunohistochemistry for the expression of BMP-2 and Aggrecan. BMP-2 protein was detected intracellular in normal and in osteoarthritic cartilage. Extracellular BMP-2 was detected exclusively in osteoarthritic cartilage and exhibits characteristic extracellular patterns: samples with BMP-2 in the extracellular matrix show BMP-2 negative coronae around BMP-2 positive cells. There is a statistically significant increase in the prevalence of extracellular BMP-2 with increasing ICRS grade/Mankin grade. Aggrecan was detected in the extracellular matrix und exhibited coronas throughout all layers. A decline of extracellular Aggrecan with increasing ICRS grade could be observed. Normal cartilage shows no intracellular Aggrecan whereas an increase in the prevalence of intracellular Aggrecan could be detected in osteoarthritic cartilage. The appearance of intracellular Aggrecan is often associated with extracellular BMP-2. The detection of BMP-2 protein in normal as well as in osteoarthritic cartilage highlights the importance of BMP-2 in tissue homeostasis and point to a putative role for maintaining tissue integrity during the development of osteoarthritis. The co-appearance of extracellular BMP-2 and intracellular Aggrecan indicates a functional relationship. The most interesting result is the characteristic distribution of extracellular BMP-2. These coronas seem to have an impact during progression of osteoarthritis and need to be further investigated.

The aim of this study was to detect characteristic structural changes in the cartilage composition of osteoarthritis (OA), hereby improving the arthroscopic identification of cartilage pathology by the use of a non-destructive technique - NIRS (Near-Infrared Spectroscopy). 682 cartilage samples out of 25 knees with OA were classified visually, using the ICRS system, biophotonically, histologically (n = 66), using the Score of Mankin and the Score of Otte, and biochemically (n = 616), determining the content of glycosaminoglycan (GAG) and hydroxyproline (HP). Significant correlations were found between biophotonical, histological, biochemical and visual characteristics of cartilage lesions. NIRS values corresponded to the content of GAG, HP and to the Score of Mankin and Otte. The data show that changes in the composition and structure of articular cartilage influence the optical properties and can be measured objectively by NIRS. The ease of use during arthroscopy, the quick response and the non-destructive nature of NIRS make it a promising addition to the assessment of disease intervention in OA.